Assessment Timing and Location

Assessment is most successful in an inpatient setting. Both suspicion and opportunity tend to arise when the child presents with acute physical or psychiatric illness. Admission is frequently suggested as the best way to distance the parent from the child, provide additional diagnostic assessment of the child's complaints, and protect the child until a differential diagnosis is completed.

Optimally, the MBP protocol pulls together a clinical management team that has access to professional consultation regarding clinical care, child protection, documentation, and legal case management (see Table 12-2). Hospital child maltreatment or psychiatric consultation teams should be specifically trained about MBP and promptly contacted when medical or psychiatric units raise concerns about a case.

Implementing an MBP hospital protocol not only reduces the likelihood that individuals or units will make legal errors in managing suspected cases but also provides documentation of parental informed consent, execution of mandated legal duties, and evidence of a process of thoughtful "professional judgment" that is the best defense in the event of formal complaints against professional licenses or malpractice lawsuits. Use of a protocol reduces the number of false allegations and improves the chances that genuine MBP cases are identified and that the level of clinical risk to a child is accurately assessed. This, in turn, increases the likelihood that when required to respond to a case, state authorities will temporarily place the child out of the home or appoint a guardian to make medical decisions pending the outcome of further investigation.

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